The Effect of Posterior Neurectomy as A Method of Surgical Parasympathectomy of the Nasal Mucosa for Management of Refractory Rhinitis

Authors

1 Department of Otorhinolaryngology -Faculty of Medicine- Minia University, Egypt

2 Department of Ear, Nose and throat, Faculty of Medicine- Minia University, Egypt

Abstract

Objectives: According to the World Health Organization (WHO) definition, idiopathic rhinitis is 
a case of allergic rhinitis (AR) that occurs for more than 4 days per week and lasts for more than 
4 consecutive weeks. The ramus specifically innervating the nasal mucosa called the posterior 
nasal nerve. Selective resection of this ramus dennervate nasal cavity from its parasympathetic 
supply and provides the same advantages of vidian neurectomy, without having its complications. 
Methods: This prospective study includes 30 adult patients diagnosed AR with failed medical 
treatment. The fibroneurovascular bundle including the Sphenopalatine Nerve emerging from the 
sphenopalatine foramen and the crista ethmoidalis is the landmark where the fibrovascular bundle 
is seen emerging from the foramen behind it. The nerve is carefully dissected from the artery by 
sickle knife and both ends are cauterized. All patients were evaluated in terms of rhinorrhea, 
sneezing and quality of life with Japanese Rhino-conjunctivitis Quality of Life Questionnaire 
(JRQLQ) classification prior to treatment and at 1, 3 and 6 months during the follow-up period. 
Results: Throughout the 6 months follow-up period, a significant difference in the degree of 
rhinorrhea and quality of life could be identified before and after posterior neurectomy. While 
sneezing improvement was minimal, before and after neurectomy. Posterior neurectomy was well 
tolerated by the patients, with no serious complications. Conclusion: posterior neurectomy seems 
to be a safe and efficient therapy for improvement of allergic rhinitis symptoms.

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